Nomogram may predict Community-acquired pneumonia in Diabetics

Researchers from China conducted a study that developed a nomogram that can help in the early identification and discrimination of community-acquired pneumonia in diabetic patients. The study results were published in the journal BMC Pulmonary Medicine.  

There is a soaring risk of developing community-acquired pneumonia (CAP) in diabetic patients which can further progress to severe CAP. It is necessary to develop predictive tools at the onset of the disease for early identification and intervention. Hence researchers from China conducted a retrospective cohort study to develop and validate a clinical feature-based nomogram to identify diabetic patients with CAP at risk of developing severe CAP. 

Between January 2019 to December 2020, nearly 1026 patients with CAP were admitted to 48 hospitals in Shanghai and were enrolled in the study. Participants were randomly divided into the training and validation samples with a ratio of 7:3. Based on the results of the multivariate logistic regression analysis and other predictors with clinical relevance, the nomogram for the prediction of severe CAP development was established. The nomogram was then assessed using receiver operating characteristic curves (ROC), calibration curves, and decision curve analysis (DCA). 

Results:

• Chronic kidney dysfunction, malignant tumor, abnormal neutrophil count, abnormal lymphocyte count, decreased serum albumin level, and increased HbA1c level at admission was independently associated with progression to severe CAP in diabetic patients as per the multivariate analysis.
• Based on these above risk factors and other predictors with clinical relevance, a nomogram was developed.
• The area under the curve (AUC) of the nomogram was 0.87 (95% CI 0.83–0.90) in the training set and 0.84 in the testing set (95% CI 0.78–0.90).
• Excellent agreement was seen between the predicted possibility by the nomogram and the actual observation as per the calibration curve.
• As per the decision curve analysis, the nomogram was applicable with a wide range of threshold probabilities due to the net benefit. 

To estimate early the probabilities of severe CAP development in diabetic patients and assess its progression to severe CAP, Nomogram can be used due to its good prediction accuracy and discrimination abilities. As these biomarkers are commonly used they can be used in clinical practice and improve the early management of diabetic patients with CAP. 

Further reading: Tan, R., Liu, B., Zhao, C. et al. Nomogram for prediction of severe community-acquired pneumonia development in diabetic patients: a multicenter study. BMC Pulm Med 22, 403 (2022). https://doi.org/10.1186/s12890-022-02183-9